The AIDS Epidemic in San Francisco: The Response of Community Physicians, 1981-1984, Vol. I
More on BAPHR's Safe Sex Guidelines
HughesDid you go to the National Lesbian/Gay Health Conference in Denver in 1983?
Andrews
Yes, I did.
Hughes
Apparently, that was a very hot meeting. I guess BAPHR's safe sex guidelines had just come out, because there was a reference to secretions and excretions, and that precipitated a lot of fireworks. Do you remember any of this?
Andrews
Sorry, I don't remember too much. I know I was there; I remember it being very intense. My recollection is that our safe sex guidelines were, as I said earlier, the first ones really formulated anywhere in the country. And when we brought them there to talk about them, the people that had not been a part of the ongoing discussion about what is safe and safer were very worried about saying things like "secretions and excretions," secretions--sweat, saliva. I remember things like, "Totally safe is dry kissing. Wet kissing, questionably safe." Who knew how much virus was in saliva and how infective it was? And people responded, "What do you mean, we're going to say people can't kiss? Come on!" It was: "Well, we don't know. Are we going to reassure people about something that may get them infected? We don't know if this is like hepatitis or what." Of course we realized that if the virus could be easily transmitted by kissing, then everyone would have been infected, and this clearly wasn't the case. So that was a very, very hot thing, and it was the breaking in of our safe sex guidelines to a national audience.
I remember a lot of people thought they were very good and were using them. There was just controversy about them. There was support, and there was wariness about them. And of course there would be, because no one had any definitive answers.
Hughes
Would it also have been the first opportunity for many of the attendees to learn in detail about the epidemic?
Andrews
I think so. I think not only learn about the epidemic, but [also about] the bathhouse stuff.
There was discussion about what to do even then, and most of these people who were coming in from all over the country really hadn't had the intense prolonged discussions that we had been having here in San Francisco. So I think [the conference] was a first exposure for a lot of people to upsetting stuff.
Then in May of 1984, Marcus Conant and others at UCSF organized a symposium to develop guidelines on AIDS risk factors. In other words, doing what BAPHR had already done. And there must have been some ruffled feathers, because apparently nobody from the community was invited to participate, and in fact, BAPHR was explicitly not invited.
Andrews
I don't remember that. I certainly knew Marc Conant and all those [UC] people; we talked to each other on the phone quite a bit during those times. [tape interruption]
Hughes
What I'm showing Dr. Andrews is a comparison of the UCSF-generated safe sex guidelines and the ones that BAPHR had come up with. The safe and the definitely not safe categories are not that far apart, but it's the middle ground that's very different.
Andrews
The middle ground has always been the point of contention. Massage, cuddling--we all knew that was safe. It was the possibly safer--they call it the suspected high risk--where all the controversy was, because no one knew at that time [whether it was safe or not].
UCSF said that documented high risk was fisting and anal intercourse, and we said unsafe was fisting, anal intercourse without a condom, rimming, blood contact, sharing sex toys, semen or urine in the mouth. What's interesting is that all the activities that we said were documented high risk, we know now are high risk, very high risk, with the exception of urine. I think we were right on.
The months that we spent on those guidelines, and we revised them several times, really reflected pretty accurately [our] epidemiological knowledge of how disease is transmitted and what we knew of sexual practices. We were pretty frank about sex toys: if you insert one toy and then insert it in the other partner, you could have disease transmission. It was so frank that it was sort of distasteful, even to some gay men. I mean, you had to look at all these sexual practices and say, "Sex toys and rimming--oh, my god." That had hardly even been talked about in the gay community, and now we were starting to have to talk about oral-anal contact. That was not a popular thing to be talking about. [laughter]
Hughes
Still isn't.
Andrews
That's right, absolutely.
Hughes
Has the federal government come out with guidelines that use that terminology?
My understanding is that some of the safe sex guidelines that came out--now, this would have been some years ago--did have this kind of terminology, because they were written in the language the community could understand. This was when [Dr. C. Everett] Koop was surgeon general. But at the same time, there was primarily Republican conservative backlash to try to stop all funding, and they did pull back all funding to anyone that said anything that was offensive, so we had to use only scientific terminology. So you had to educate people with words they didn't know what the hell they meant. It was a typical American puritanical response to how you handled social problems. Pathetic. [laughter]
Hughes
As of August of '84, BAPHR offered safe sex guidelines in a variety of formats. I'll just refresh your memory?
Andrews
Yes, please.
Hughes
One was a wallet-sized card which was passed out in many places, including the Gay Pride Day parade, and was also available at the baths.
Andrews
That's right.
Hughes
Then there was a short brochure in the form of a letter in street language--just what you were talking about--written by one gay man to another. And then there was a longer brochure which had a scientific bent.
Andrews
That's right.
Hughes
And then there was an update of the original brochure. So there were four different formats. It seems to me that the attempt here was to draw in as many different segments of the population under as many different circumstances as you possibly could.
Andrews
That is exactly right. For several years when we marched in the parade, we had those little cards. Every one of us passed out hundreds of cards as we were marching, in addition to being at the booth. The brochure [produced] with the Sisters of Perpetual Indulgence was written in street language, and they helped support it. We came up with the wording, and then the Sisters of Perpetual Indulgence helped do some of the publishing. They did lots of distributing, even though it was from us. They took what we had. And then ultimately, the AIDS Foundation.
Hughes
The AIDS Foundation came out with guidelines. Are they yours?
Yes. I think if we were to look at them, they are almost identical, because we had major input into what their guidelines were.
Hughes
So the AIDS Foundation was a mechanism for getting them out in the community.
Andrews
Right.
Hughes
What was the handkerchief code?
Andrews
I have a hunch that that might have been started under the direction of Will Warner. I don't know if he was president then, but Will, as I said, had been very active in the leather community, and I think this was a personal interest of his to help people identify what people were into sexually so they could link up better. That's what it really was. The handkerchief was all the guides to what people were into sexually. Passive, active, oral sex, rectal sex, toys, rimming, golden showers--a lot of sort of fringe-y stuff that only the cult knew about. It was like shorthand. "Now I know what you and I can do because you're wearing that handkerchief, so I don't have to ask you; I know what I'm getting."
Hughes
The code didn't really have anything to do with safe sex, did it?
Andrews
I don't think it did. I don't know if part of that card had safe sex guidelines or if it was strictly just a hanky identification. It may have been just that.
Hughes
In the write-ups, I didn't see any juxtaposition of those two things. I thought that the handkerchief code had something to do with safe sex, but it doesn't sound that way.
Andrews
There may have been a handkerchief that said, "Safe sex only," or "Condoms only." I don't recall that at all.
Hughes
The guidelines were revised in 1986. Did you have any part in that?
Andrews
I don't remember.
Hughes
Is there anything general to be said about the tenor of the guidelines over time? Do they get more definite, for example?
Andrews
I think that over time and with the identification of the virus, they became clearer, but I think there's very little alteration over time from what we thought in the very beginning. There were some little changes, but we were fairly accurate about the fact that if you don't wear a condom, that's the risk. Now, early on,
But the basic guidelines we came up with, although they were refined, I think in general stayed pretty much the same.
Hughes
Around 1983-1984, the rate of new [HIV] infections, and also the rate of other STDs, dropped. Was some of the drop because of the pervasiveness of these guidelines?
Andrews
I think it must have been. Before AIDS, we saw a speeding "train" pushing every frontier toward every kind of sexual expression. And then the train began to derail. As the years went on and there were more and more cases and it became more and more clear that this was a sexually transmitted disease, a larger percentage of people began to be convinced that totally unprotected, frequent sex put you at extreme high risk for death. Some people changed, some people didn't. But I think it had a huge impact on the people that might have had unprotected, frequent sex. It was once perceived as, "Okay to and there's no big deal; you just get a shot [to cure whatever STD you might get]." [And changed] to: "Whoops, now the stakes are, I may die, and die quickly." The whole epidemic had a huge sobering impact on everyone.
Hughes
I would think one of the most sobering impacts would be seeing your friends and lovers die.
Andrews
Absolutely.
Hughes
And not only die quickly, but--
Andrews
Horribly.
Courtesy of Regional Oral History Office, University of California, Berkeley
http://content.cdlib.org/view?docId=kt6580067h&brand=oac4
Title: The AIDS Epidemic in San Francisco: The Response of Community Physicians, 1981-1984, Vol. I
By: Sally Smith Hughes
Date: 1996
Contributing Institution: Regional Oral History Office, University of California, Berkeley
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